POS0458 HAVING MORE TENDER THAN SWOLLEN JOINTS IS ASSOCIATED WITH WORSE FUNCTION, PAIN INTERFERENCE, SOCIAL PARTICIPATION AND OTHER HR-QOL OUTCOMES IN THE FIRST YEAR FOLLOWING RA DIAGNOSIS: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT STUDY
Authors: C. Meng, Y. Lee, O. Schieir, M. F. Valois, M. Butler, G. Boire, G. Hazlewood, C. Hitchon, E. Keystone, D. Tin, C. Thorne, L. Bessette, J. Pope, S. J. Bartlett, V. Bykerk
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Newly diagnosed RA patients seen in routine care may present with more tender than swollen joints, that can persist throughout their early RA treatment. Little is known, about the impact of these tender-swollen joint count differences (TSJD) on patient-reported outcome measures (PROMs), such as function, pain interference, social participation and other health-related quality of life (HR-QoL) outcomes. <h3>Objectives</h3> Our objective was to estimate the impact of TSJD on PROMs in the first year following RA diagnosis, and whether associations may vary by type of joint involvement (small vs large). <h3>Methods</h3> Data were from patients with active, early RA (symptoms&lt;1 year, CDAI&gt;2.8) enrolled in the Canadian Early Arthritis Cohort (CATCH) who completed detailed clinical assessments and PROMs including the PROMIS-29 (physical function, social participation, pain interference, fatigue, sleep disturbance, anxiety and depression) at baseline, 3-,6- and 12-month between Jan 2016 and Aug 2022. 28-tender and 28-swollen joint counts (including 6 large and 22 small-joints) were performed by rheumatology team members. TSJD were calculated by subtracting SJC from TJC at each visit and categorized as &lt;=0, 1-4, 5-6, 7+. Adjusted associations between repeated measures of TSJD and PROMIS-29 HR-QoL domains were estimated in separate linear-mixed models adjusted for age, sex, education, smoking, comorbidities, osteoarthritis/back pain, and RA treatment. Stratified analyses by large vs small TSJD were also performed to examine potential differential impacts by joint distribution. <h3>Results</h3> 547 eligible early RA patients (70% female, mean (SD) age 56(15) years, mean (SD) disease duration 5.3 (2.9) months) evaluated at baseline. 287 (52%) had TSJD score&gt;0. Of these, scores ranged from 1 to 4 in 200 (37%), 5 to 6 in 41 (8%) and 7+ in 46 (8%). The frequency of TSJD&gt;0 decreased from 52% at BL to 32% at 12-months. Adjusted mean-change scores in all PROMIS-29 measures were worse with higher TSJDs over 1-year follow-up (Figure 1). TSJD 1 to 4 and &gt;7 were associated with worse mean-change T scores for all PROMIS29 outcomes, with TSJD&gt;7 showing more pronounced worsening in physical function -2.6 [-4.0, -1.2] and participation satisfaction -3.5 [-5.3, -1.7] (negative scores indicating more impairment). Worse mean-change T scores in symptoms were also associated with TSJD&gt;7 (positive scores indicating worse symptoms): pain interference 5.2 [3.5,6.9], fatigue 4.0 [2.1, 5.8], sleep problems 3.0 [1.4, 4.5], anxiety 2.1 [0.4, 3.8] and depression 2.0 [0.4, 3.7). There were fewer scores of TSJD 5 to 6, which was associated with worse mean-change scores in function, social participation and pain interference. The most striking mean-change scores were seen for large joint-TSJD scores of 5 to 6 in PROMIS function -6.1 [-10.3, -1.9] and social participation -6.1 [-11.6, -0.6], pain interference 6.6 [1.5, 11.7], compared to those found with small joint-TSJD and 28 joint-TSJD. Large joint -TSJD scores 1 to 4 were also associated with worse mean-change scores for all PROMIS measures. <h3>Conclusion</h3> Over half of patients with eRA have more tender than swollen joints, which persists in a third of patients. An increased TSJD score is associated with worse function, pain interference, social participation, and other HR-QoL outcomes over 1-year of follow-up. TSJD thresholds of 1 to 4 and &gt;7 were associated with worsening of all PROMIS-29 outcomes. Having more tender than swollen large joints, at thresholds of 1 to 4 and 5 to 6, was associated with the most pronounced worsening of PROMs. Elevated TSJD assessment, especially in large-joints may help identify patients likely to experience worse outcomes. The impact from and persistence of predominantly tender joints supports a need to identify early interventions. <h3>REFERENCES:</h3> Hammer. Rheumatology Advances in Practice 2021:0;1-6. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Charis Meng: None declared, Yvonne Lee Shareholder of: Cigna, Grant/research support from: Pfizer, other payment to medical writer from Sanofi Genzyme, Orit Schieir: None declared, Marie-France Valois: None declared, Margaret Butler: None declared, Gilles Boire Paid instructor for: Abbvie, BMS, Orimed Pharma, Viatris, Consultant of: Abbvie, BMS, Gilead, Janssen, Lilly, Mylan, Novartis, Pfizer, Samsung Bioepis, Sanofi, Teva, Viatris, Grant/research support from: BMS, Eli Lilly, Janssen, Merck, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Speakers bureau: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Consultant of: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: Pfizer, UCB Public Health Agency of Canada, Research Manitoba, Health Sciences Centre Foundation, Edward Keystone Speakers bureau: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Consultant of: AbbVie, Amgen, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, Diane Tin: None declared, Carter Thorne Speakers bureau: Medexus/ Medac, Consultant of: AbbVie, Centocor, Janssen, Medexus; Novartis Pfizer; Sandoz; Sanofi, Grant/research support from: Pfizer, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Sanofi, Lilly, Novartis, TEVA, Fresenius Kabi, Sandoz, Organon, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Sanofi, Lilly, Novartis, TEVA, Fresenius Kabi, Sandoz, Organon, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Janet Pope Speakers bureau: UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly &amp; Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: AbbVie, BMS, Eli Lilly &amp; Company, Merck, Roche, Seattle Genetics, UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, AbbVie, Vivian Bykerk Paid instructor for: Honoraria/Consulting: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB;, Consultant of: Honoraria/Consulting: Amgen, Bristol Myers Squibb, Genzyme, Gilead, Janssen, Pfizer, Sanofi-Aventis, UCB;, Grant/research support from: institution received grants from Bristol Myers Squibb and Amgen.